Frontline Health workers – The Warriors of COVID-19 Outbreak: Psychological Concerns and Assistance in Indian Context

1 Department of Clinical Psychology, Institute of Psychiatry- Centre of Excellence, Kolkata

2 Department of Clinical Psychology, Institute of Psychiatry- Centre of Excellence, Kolkata

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*Address for correspondence: Pourabi Chaudhury, Assistant Professor, Department of Clinical Psychology, Institute of Psychiatry – Centre of Excellence, 7, D.L. Khan Road, Kolkata. Email: pourabi.chaudhury@gmail.com

On January 31, 2020, the World Health Organization (WHO) declared the corona virus outbreak a Public Health Emergency of International Concern.[1]In the current scenario where the entire world is grappling with the appropriate measures that needs to be adopted in order to curb the spread of the COVID – 19 pandemic, it threatens us to become an endemic like HIV as warned by the World Health Organisation’s latest reports.[2] Health workers are identified as the frontline workers of the COVID – 19 outbreak response by the World Health Organisation[3] and it is a known fact that they are of utmost importance in alleviation of this current calamity.

Frontline health workers are the backbone of an effective health system and they play a critical role in providing health solutions along with connecting families and communities to the health system. They are those directly providing services where they are most needed including remote and rural areas. They are the first and often the only link to health care for millions of people and are capable of providing many life-saving interventions. Frontline health workers are also increasingly critical to addressing diseases that impact the health around the world like the current COVID-19 pandemic. Frontline workers have been proven time and again as central pillars of health and there is abundant evidence that well supported frontline health workers bring about essential improvements in health conditions especially during situations like current COVID-19 pandemic. As the latest number of confirmed cases in the 2019 novel coronavirus disease (COVID-19) updates multiple times a day and the death toll continues to rise, the world holds its breath, and health workers continue to fight the outbreak on the front lines.

As a consequence of the service they are rendering, the health workers are exposed to certain inevitable hazards. It goes without saying that the dire risk of contracting the virus is the most prominent hazard they are confronted with. However, psychological distress is also one of the significant hazard which is of no less importance.[3]Need for sensitivity about the psychological consequences and assistance regarding the same in such a scenario is of utmost significance both in the short term and long term,[4]along with providing the training, support, and supplies they need.“If we can’t keep our doctors and nurses safe, how can they—and we—fight dangerous pathogens and keep us all alive?” said Dr. Leana S. Wen, a physician and health workforce equity advocate, in a piece published in USA, February 17, 2020.[5] The February 7, 2020 death of 33-year-old Li Wenliang, the Chinese doctor who provided an early warning on coronavirus, is a reminder of health workers’ sacrifices during an outbreak of such magnitude[6]. The unparalleled role of the frontline medical staff and their endeavour in these days of crisis is largely talked about. Also, we should keep in mind that it is not only the doctors and nurses who are serving the infected patients but a lot of other people like the radiologists, the biochemists, ICU and CCU technicians, scavengers, like a team. Thus, the psychological distress experienced by them and the frontline medical staffs are of comparable significance. In their study, Li et al.[7] have further indicated that the vicarious traumatisation of the non-frontline nurses was more severe than the frontline nurses which demonstrated how the consequences of the outbreak have exceeded the psychological and emotional tolerance capacities of the individuals. Even studies done after previous epidemics like the SARS outbreak showed that psychological stress was greatest for emergency nurses, followed by emergency doctors, and then for healthcare assistants.[8]

The COVID-19 pandemic has re-established the role of health workers, especially frontline health workers in our society. In these grim times, when the pandemic has pushed millions of people across the world into hospitals, the frontline health workers have tougher tasks at hand and they aren’t giving up just yet. Globally, frontline health workers have been at the forefront of the battle against an unparalleled threat the COVID-19 pandemic and is displaying tremendous strength, commitment, and compassion in this uncertain time. How to best support, manage, and protect these individuals—which includes not just physicians but also nurses, emergency responders, food service workers and all staff interacting with patients—remains an open question.

In the Indian context some psychological concerns among the frontline medical staffs, nurses, allied health professionals and support staffs dealing with people affected with COVID-19, some of which were again comparable with the rest of the world can be briefed up as under:

  1. Worry regarding safety is an ongoing issue in responding to the COVID-19 outbreak.
  2. Constant availability of the personal protective equipment (PPE) is an area of concern since shortage of such equipment scared not only the workers in India but the entire world and moreover existence of chances of contamination in-spite of PPE being present induced worry.
  3. The hospital staffs are anxious about bringing back home the virus even more than self- infection.
  4. It can also be seen how frontline health workers are exhausted with long shifts and staff shortages. The excessive work pressure they faced due to upsurge in the number of people infected goes without saying is present. They not only care for coronavirus patients but are also keeping up with all their other everyday demands like vaccinations, and so much more. WHO estimates global shortfall of 5.9M nurses as world battles COVID-19.[9] This in turn has an impact on having their ability to keep themselves and their clients safe.
  5. Witnessing so much of infection, deaths and providing physical and psychological support to the infected, leave them at times traumatised with feelings of helplessness.
  6. Sufficient knowledge regarding handling the psychological issues faced by infected individuals along with those who are quarantined.
  7. Fear of being demarcated and stigmatised because of the service they are rendering.The primary techniques of psychological assistance or support, beneficial for this workforce of unsurmountable importance is imparting psychological first aid and training in coping strategies to build up resilience. These broad domains of psychotherapeutic manoeuvres may be elaborated as follows:
  1. It is very important and desirable to listen to them, facilitate them to voice out their need and share experiences of stigma if they have encountered. They should always be encouraged give inputs regarding what can be done for further management of the health workers during this pandemic. They should be encouraged to tell their stories of strength and given a global platform to share their experiences and expertise.
  2. It is of prime importance to stabilize those among them who are emotionally overwhelmed on being a witness of this daunting situation.
  3. Frontline health workers need on-the-job safety every day most particularly during a pandemic. Communicating to those concerned that it is an obligation and duty to keep frontline health workers everywhere safe, including making sure all have the personal protective equipment (PPE). Further health workers should be routinely tested for COVID-19 as their early testing may help to reduce the workforce shortage caused by quarantines if the infection spreads among workers. Equipped with essential supplies and given necessary logistic support to facilitate their work may in turn gives them confidence, identity and prestige.
  4. Health workers must be equipped with the information, resources, and protection in order to provide the necessary care. For this purpose, appropriate available digital health tools can be used to connect health workers to information.
  5. Imparting training to handle the immediate psychological issues of the quarantined and infected is also of significance.
  6. Temporary accommodation facility should be organized for every frontline health worker. This will help more health workers (particularly women who make up the bulk of the health workforce and who tend to have more caretaking responsibilities at home) keep their families safe from infection and lower stress on the job.
  7. Helping build an excellent supportive team of health workers who encourages each other, stays beside each other during turmoil along with having an understanding and reassuring family who acknowledge their outstanding feat is of prime importance.
  8. Preliminary coping skills that can be effective for handling this crisis can be practicing relaxation exercises, having adequate rest in between work and stepping out from their work station for short break to engage in hearty conversation with colleagues.
  9. The frontline health workers need a relief from burnout protecting their physical and mental health. They should be offered regular psychological support when they need it for depression, burnout, anxiety for themselves and their family members. It is required for their encouragement, motivation to continue their work and also to express their struggles and burden of work.

Every country builds an army of frontline health workers capable of preventing diseases and outbreaks. Right to life may not always equate to right to health. Therefore, it is important that every countries’ constitutions specifically mention right to health. Let’s take care of each other, we have a long road ahead.

References

  1. World Health Organisation [Internet]. Geneva: World Health Organisation; c2020 [cited 2020 Jan 31].Coronavirus disease (COVID – 19) pandemic. Available from:

https://www.who.int/dg/speeches/detail/who-director-general-s-statement-on-ihr-

emergency-committee-on-novel-coronavirus-(2019-ncov)

  1. timesnownews.com [Internet]. India: Timesnownews.com; c2020 [cited 2020 May 14].

Available from: h ttps://www.timesnownews.com/international/article/coronavirus-could-

become-endemic-like-hiv-and-may-never-go-away-warns-who/591592

  1. Coronavirus disease (COVID-19) outbreak: rights, roles and responsibilities of health workers, including key considerations for occupational safety and health [PDF]. 2020. Geneva: World Health Organization.
  2. Mohindra R, Ravaki R, Suri V, Bhalla A, Singh SM. Issues relevant to mental health promotion in frontline health care providers managing quarantined/isolated COVID-19 patients. Asian Journal of Psychiatry. 2020 Apr 7.
  3. intrahealth.org [Internet]. USA: Intrahealth international. c2020 [cited 2020 Feb 13]. Available from:h ttps://www.intrahealth.org/vital/frontline-health-workers-mustbe

priority-coronavirus-response

  1. nytimes.com [Internet]. New York: The New York Times. c2020 [cited 2020 Feb 07]. Available from:h ttps://www.nytimes.com/2020/02/06/world/asia/chinese-doctor-Li

Wenliang-coronavirus.html

  1. Li Z, Ge J, Yang M, Feng J, Qiao M, Jiang R, Bi J, Zhan G, Xu X, Wang L, Zhou Q. Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control. Brain, behavior, and immunity. 2020 Mar 10.
  2. Wong TW, Yau JK, Chan CL, Kwong RS, Ho SM, Lau CC, Lau FL, Lit CH. The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. European Journal of Emergency Medicine. 2005 Feb 1;12(1):13-8.
  3. devex.com [Internet]. Washington, D.C.: Devex. c2020 [cited 2020 April 07]. Available from: https://www.devex.com/news/who-estimates-global-shortfall-of-5-9m-nurses-as-

world-battles-covid-19-96952